Efficacy of liraglutide as a follow-up therapy after resolution of glucotoxicity with intensive insulin therapy.

OBJECTIVE: To assess the utility of liraglutide, a GLP-1 receptor agonist, as additional therapy following resolution of glucotoxicity with insulin therapy. METHODS: The subjects were 13 Japanese patients with short-duration type 2 diabetes mellitus (2.0 ± 2.1 years). At first, treatment with insulin therapy consisted of bolus insulin before each meal and basal insulin at bed time commenced to improve every preprandial glucose levels below 130 mg/dL. Then, insulin therapy was replaced with liraglutide monotherapy in case in which 50% or more self-monitoring of blood glucose (SMBG) tests revealed preprandial glucose levels of less than 130 mg/dL at least for one month. Liraglutide dosing was initiated at 0.3 mg/day and increased in weekly or biweekly increments of 0.3 mg/day, to the maximum permissible dose (in Japan) of 0.9 mg/day. The participants were treated with liraglutide for 24 weeks. RESULTS: The average insulin therapy period was 13.2 ± 5.4 weeks, and insulin therapy significantly improved HbA1c values from 12.4% ± 1.6% to 6.8% ± 0.9% (P < 0.05). After improvement of hyperglycemia with insulin therapy and switching to liraglutide monotherapy for 24 weeks, HbA1c values remained constant (6.2% ± 1.0% at week 24) and the rates of hypoglycemic episodes significantly decreased (P < 0.05). CONCLUSIONS: These data suggest that liraglutide is proposed as an alternative follow-up therapy subsequent to eliminate glucotoxicity with insulin therapy.